MEDICARE: DR. DANIEL J CHACHKO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1896	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	290747773003	OTHER	OH	MMOH
2	000000141154	OTHER	OH	BCBS

General Provider Information

NPI Number	:	1083662902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL J CHACHKO DC

Provider Business Mailing Address
First Line	:	PO BOX 423
Second Line	:
City	:	NEWTON FALLS
State	:	OH
Zip	:	44444-1261
Country	:	US
Telephone Number	:	330-872-1500
Fax Number	:	330-872-1466

Provider Business Practice Location Address
First Line	:	119 RIDGE RD
Second Line	:	SUITE B
City	:	NEWTON FALLS
State	:	OH
Zip	:	44444-1261
Country	:	US
Telephone Number	:	330-872-1500
Fax Number	:	330-872-1466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	01/19/2011

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